Provider Demographics
NPI:1093709826
Name:BEAVERCREEK FAMILY CARE ASSOCIATES LTD
Entity Type:Organization
Organization Name:BEAVERCREEK FAMILY CARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-431-3700
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE #275
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-431-3700
Mailing Address - Fax:937-431-3705
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE #275
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-431-3700
Practice Address - Fax:937-431-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0528263Medicaid
OHA15336Medicare UPIN
OH0528263Medicaid